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DOI: 10.1055/a-2510-7031
Preferred Working Time Models and Equal Opportunities in Gynecology and Obstetrics: Results of the Systematic Trinational FARBEN Survey
Favorisierte Arbeitszeitmodelle und Gleichberechtigung in der Gynäkologie und Geburtshilfe: die Ergebnisse der systematischen trinationalen FARBEN-Umfrage
- Abstract
- Zusammenfassung
- Introduction
- Methods
- Results
- Discussion
- Strengths and Limitations
- Conclusions
- Contribution to the Manuscript and Online Survey
- Details of Ethics Approval
- Supplementary Material
- References
Abstract
Introduction
The trinational survey project conducted by the Young Forums of the German, Austrian, and Swiss Societies for Gynecology and Obstetrics aims to assess the preferences of prospective and practicing gynecologists regarding various work-time models, the compatibility of family and career, as well as parental leave.
Materials and Methods
Between October 2023 and May 2024, a total of 1364 participants took part in the survey. The questionnaire consisted of 62 questions covering topics such as the workplace in general, work-time models, training priorities, team compositions, and professional goals. Participation was voluntary and anonymous.
Results
Of the 1364 participants, 75.3% were employed in Germany, 12.9% in Austria, and 11.8% in Switzerland. Men were significantly more likely to aspire to a chief physician position compared to women (26.5% vs. 3.6%; p < 0.001). Only 12.5% of participants overall preferred full-time employment, although 63.0% of residents worked full-time. Additionally, 65.4% of respondents stated that their workplace did not provide childcare with flexible hours. At the same time, 76.0% valued workplace-proximate childcare as an important factor in choosing an employer.
Conclusions
The results highlight heterogeneous and individual needs and priorities among all (prospective) gynecologists. At a time when individuality and equality are becoming increasingly significant, it is essential to promote work environments that meet the demands and needs of all physicians. The results should therefore be critically discussed to implement potential adjustments and improvements in practice.
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Zusammenfassung
Einleitung
Das Ziel dieses trinationalen Umfrageprojekts, das von den Jungen Foren der Deutschen und Schweizer sowie der Jungen Gyn der Österreichischen Gesellschaft für Gynäkologie und Geburtshilfe durchgeführt wurde, war die Präferenzen angehender und aktiver Gynäkolog*innen hinsichtlich verschiedener Arbeitszeitmodelle, der Kompatibilität von Familie und Beruf sowie der Elternzeit zu evaluieren.
Material und Methoden
Zwischen Oktober 2023 und Mai 2024 nahmen insgesamt 1364 Teilnehmer*innen an der Umfrage teil. Der Fragebogen bestand aus 62 Fragen, die Themen wie Arbeitsplatz im Allgemeinen, Arbeitszeitmodelle, Ausbildungsschwerpunkte, Team-Zusammensetzungen und berufliche Ziele abdeckten. Die Teilnahme an der Umfrage war freiwillig und anonym.
Ergebnisse
Von den 1364 Teilnehmer*innen waren 75,3% in Deutschland, 12,9% in Österreich und 11,8% in der Schweiz tätig. Männer strebten signifikant häufiger eine Chefarztposition an als Frauen (26,5% vs. 3,6%; p < 0,001). Insgesamt zogen nur 12,5% der Teilnehmer*innen eine Vollzeitbeschäftigung vor, obwohl 63,0% der Ärzt*innen in der Facharztausbildung Vollzeit arbeiteten. Hinzu kommt, dass 65,4% der Umfrageteilnehmer*innen angaben, dass ihr jeweiliger Arbeitsplatz keine Kinderbetreuung mit flexiblen Betreuungszeiten zur Verfügung stellte. Gleichzeitig schätzten 76,0% eine arbeitsplatznahe Kinderbetreuung als wichtiger Faktor bei der Auswahl ihres Arbeitgebers.
Schlussfolgerungen
Die Ergebnisse zeigen die heterogenen und individuellen Bedürfnisse und Prioritäten aller (angehenden) Gynäkolog*innen auf. In einer Zeit, in der Individualität und Gleichberechtigung zunehmend an Bedeutung gewinnen, ist die Schaffung von Arbeitsumgebungen, die den Anforderungen und Bedürfnissen aller Ärzt*innen gerecht werden, unerlässlich. Diese Ergebnisse sollten daher kritisch diskutiert werden, um potenzielle Anpassungen und Verbesserungen in der Praxis umzusetzen.
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Keywords
working time models - equal opportunities - online survey - career goals - gender differencesSchlüsselwörter
Arbeitszeitmodelle - Gleichberechtigung - Online-Umfrage - Berufsziele - GeschlechterunterschiedeIntroduction
Different age groups often have varying needs and priorities, particularly regarding work-life balance, the reconciliation of family and career, and personal development. Pregnancy and parenthood present significant challenges for women in balancing their professional careers. Given the predominantly female medical staff, the field of gynecology and obstetrics occupies a distinctive position in this context. Specifically, 14268 out of 19530 (73%) practicing gynecologists in Germany are female, and only 489 of the 2819 (17%) gynecologists under 40 years old are male [1] [2]. In Austria, the overall proportion of male colleagues in gynecology is significantly higher, at 42%, while in Switzerland, 70% of gynecologists are female. However, 93% of the specialist titles in gynecology in 2023 have been achieved by women. In total, over 23000 physicians are registered in the DACH countries according to the respective national medical statistics, with 6% working in Switzerland, 9% in Austria, and 85% in Germany [1] [3] [4] [5].
In an era where diversity and equality are becoming increasingly important, aspects such as parental leave, flexible working models, and childcare services hold significant value. Despite this relevance, there are only a few studies with substantiated statistical data available on the topic [6]. Currently, opportunities for flexible and individualized working time arrangements in medicine are limited, even though they are considered key to improving the reconciliation of career and family while taking familial responsibilities into account [7].
While there is increasing societal and political discussion in many industries about the introduction of a so-called four-day workweek [8] [9] [10], the strain on medical personnel caused by a general shortage of physicians, rising patient volumes, and intense demands from night, weekend, and holiday shifts is significantly higher compared to other professions [11] [12]. In this context, structural improvements in professional training, focusing on secure financing, regular feedback sessions with supervisors, and enhancements in personnel management have recently been identified as potentially beneficial [13].
The Young Forum of the German Society for Gynecology and Obstetrics (DGGG e. V.), in cross-border collaboration with the Young Gynaecology Group of the Austrian Society for Gynaecology and Obstetrics (OEGGG) and the Young Forum of the Swiss Society for Gynaecology and Obstetrics (SGGG), initiated a new survey twelve years following the publication of the DGGG e. V. survey titled ‘Career and Family – A Question of Impossibility?’ [14]. This new survey focuses on additional content areas such as working time models, professional goals, and family leave, aiming to identify potential improvements based on the preferences of all current and future gynecologists and to continue pursuing positive approaches [15].
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Methods
Between October 2023 and May 2024, a total of 1364 participants responded to the online survey, initiated by the Young Forums/Young Gynaecology Groups of the DGGG e. V., OEGGG, and SGGG, as well as the University of Luebeck (FARBEN [German: Colors]: FAvorisierte aRBEitszeitmodelle in der GyNäkologie = Preferred Working Time Models in Gynaecology). Participation was anonymous.
Questionnaire
The questionnaire was designed in consensus by representatives of the Young Forums/Young Gynaecology Groups of the DGGG e. V., OEGGG, and SGGG (NT, NA, PF, AK, CB, RK), under the mentorship of Prof. Dr. Maggie Banys-Paluchowski (University Hospital Schleswig-Holstein, Luebeck Campus) and the Equality Officer of the University of Luebeck (Dr. Solveig Simowitsch). Therefore, it is a self-created, non-validated questionnaire. Additionally, the presidents of the national professional societies, Prof. Dr. Barbara Schmalfeldt (DGGG e. V.) and Prof. Dr. Bettina Toth (OEGGG), provided advisory support.
The trilingual questionnaire was created using the online tool SurveyMonkey and comprised a total of 62 questions, which could be answered in German, Italian, or French, allowing all participants to respond in their native language. Of the 62 questions, 54 (Appendix, online) were made available to all participants, regardless of nationality. In addition to these 54 questions, one supplementary question was addressed to German participants, three additional questions were posed to Austrian colleagues, and four country-specific questions were directed to Swiss colleagues, focusing specifically on their national training and healthcare systems. Overall, three of the 62 questions were formulated as free-text responses. A positive ethics approval (File Number: 2023–644) was obtained from the University of Luebeck. The wording of the questions was tailored to reflect the specific circumstances of each participating country.
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Recruitment and survey invitations
Participants were invited to take part through the social media channels of the Young Forums/Young Gynaecology Groups (Instagram), print media [15], training sessions and conferences, newsletters of the respective national gynecological societies, and during lectures for medical students. The target audience included medical students with interest in Gynecology and Obstetrics, residents, specialists, senior physicians, chief physicians, and gynecologists in outpatient practice.
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Statistical analysis
Data analysis was conducted using Excel 2311 and SPSS Statistics (V. 29.0.2.0, Armonk, NY: IBM Corp.). Multiple entries by the same individual were excluded through anonymous IP address verification. Correlations between two factors were examined using the chi-square test, with p values < 0.05 considered statistically significant. All reported p values are two-sided.
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Results
Participant characteristics
Of the 1364 participants, 75.3% worked in Germany, 12.9% in Austria, and 11.8% in Switzerland (see [Fig. 1] a). Among these, 90.8% were female, 8.9% male, and 0.4% identified as diverse. Overall, 8.9% were students, 55.8% residents, 16.0% specialists, 12.3% senior physicians, 1.2% chief physicians, and 5.8% gynecologists practicing in outpatient setting. A total of 83.2% of respondents were aged between 21 and 40 years. Among them, 61.4% had a doctorate, 26.0% did not hold an academic title, and 3.6% had completed a habilitation (highest university degree in German-speaking countries) or held a professorship. Among women, 61.9% held a doctorate, compared to 57.1% of male respondents.
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Professional goals
Overall, the majority of participants (37.9%) indicated that their professional goal was to establish their own practice (self-employment: 23.9%; employed: 14.0%), followed by senior physician position (36.7%). In contrast, the chief physician position ranked last with only 5.8% of votes. However, significant differences were observed by gender. Men were significantly more likely to aspire to a chief physician role than women (26.5% vs. 3.6%; p < 0.001) (see [Fig. 1] b). It is important to note that the desire for a chief physician position increased with age, reaching the highest preference of 13.7% among those aged 41–60 (see [Table 1]).
Participants cited night and weekend shifts (82.7%) as the primary reason against working in a hospital setting, followed by inadequate work-life balance (67.1%) and insufficient compatibility of family and professional career (74.1%).
Only 14.7% of participants expressed interest in pursuing habilitation for their careers, while 64.3% did not aspire to it, and 21.0% were undecided. Gender analysis revealed that only 12.1% of women desired habilitation, compared to 47.1% of men (p < 0.001) (see [Fig. 1] c; [Table 1]).
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Family and career compatibility
47.0% of the respondents reported having children (see [Table 2]). On average, surveyed parents had 1.9 children (1.8 for women, 2.2 for men) and were 30.8 years old at the birth of their first child (30.7 for women, 31.4 for men). When focusing specifically on the groups of senior and chief physicians, the average number of children was significantly lower for women (1.9) than men (2.6, p = 0.013). Interestingly, in these two professional categories, 9.9% of men were childless, compared to 24.5% of female respondents.
Additionally, 47.2% of the overall cohort stated there was no ‘perfect time’ to have the first child, while 22.0% identified the optimal time as after obtaining specialist qualification, and 19.9% during residency. Among all surveyed parents, only 8.2% did not take any family leave.
Only 15.4% of respondents indicated that their workplace offered childcare with flexible opening hours and sufficient capacity. Simultaneously, 76.0% of respondents noted that on-site childcare was a factor in their choice of employer.
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Working time models
When asked about their preferred working time model, only 12.5% of participants favored full-time employment, with notable differences observed between genders. Whereas 39.8% of men preferred full-time positions, only 10.8% of women shared this preference (see [Fig. 1] d; [Table 3]). The percentage of participants favoring full-time work was highest in Austria (22.8%), followed by Germany (11.8%) and Switzerland (6.4%).
Despite 44.8% of all residents expressing a desire for a part-time position (80–89%), and only 12.5% wishing for a full-time role, 63.0% of all residents were working full-time, making them the second-largest group working full-time, after chief physicians (80%).
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Part-time employment
Among respondents working full-time, 34.3% stated that part-time employees did not burden the clinical team. In contrast, 24.2% viewed the staffing situation as a burden irrespective of the part-time model. While 32.9% felt a burden was only created by part-time employees with reduced daily hours, 8.5% reported a team burden only in case of fixed days off. Many respondents proposed solutions to avoid staffing burdens, such as fixed job-sharing arrangements (where two physicians share a position, including on-call duties) or working full days with fixed days off.
Only 7.7% of respondents with children indicated that their part-time work was unrelated to parenthood, while 20.7% of part-time workers were childless. The primary reasons for choosing part-time employment were childcare responsibilities, followed by a desire for a better work-life balance and excessive workload (see [Table 1]).
The respondents could propose potential solutions to reduce staffing burdens resulting from part-time employment as free text responses. Common suggestions included the introduction of part-time scheduled consultations to prevent additional workload that needs to be covered by full-time staff. A higher staff-to-patient ratio was proposed to ease staffing gaps due to pregnancy, resignations, or illness. Additionally, respondents favored the option to work from home, especially for documentation tasks.
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Diversity and equality in gynecology
63.7% of respondents agreed (to varying degrees) that gynecologists in training face professional disadvantages due to their gender. Specific suggestions for improvement included the implementation of support programs for returning to work after a career break as well as structured training curricula for part-time workers. Overall, many participants saw a reduction in administrative activities with a stronger focus on practical skills as a possible key to improving the education and training. Targeted surgical training during pregnancy was also highlighted as an important aspect of structured medical training.
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Discussion
This trinational survey aimed to assess the diverse preferences of professionals and trainees in gynecology, focusing on working time models, work-life balance, and equal opportunities. The analysis took into account factors such as professional positions, age groups, gender, and country of residence.
The FARBEN survey is the second collaborative trinational study conducted by the Young Forums. The results of the first “D-A-CH Study” were published in 2022, providing an overview of the differences and similarities in the specialty training in obstetrics and gynecology [16] [17]. The recruited participants from each country roughly reflect the proportional national share of all gynecologists working in the DACH region (Germany: 75% of survey participants vs. 85% of all gynecologists in the DACH region; Austria: 13% vs. 9%; Switzerland: 12% vs. 6%), although Switzerland was able to recruit the highest proportion of participants relative to the total number of national gynecologists. It should be noted that students were also encouraged to respond to the survey. As a result, the proportions may have been influenced.
Our results show important gender differences in aspirations and professional goals. Importantly, significantly more (26.5%) male respondents aimed for a chief physician position, while only 3.6% of women expressed the same ambition. Over the past few decades, the number of women pursuing a medical career has steadily increased [18]. Despite this development, the increased representation of women has yet to reach the upper echelons of the medical profession [19]. In Germany, women make up only 19% of all gynecological department heads, indicating a significant underrepresentation [2]. In comparison, the proportion of female directors in other surgical specialties remains even lower [2] [20]. It remains a matter of debate whether this discrepancy stems from differing preferences or is exacerbated by structural deficiencies, such as the lack of flexible childcare options with adequate capacity or limited opportunities for individualized working time models. It is undeniable that women face unique challenges in balancing family and professional career due to pregnancy, maternity leave, and potentially breastfeeding [6] [14] [21] [22] [23]. This may also explain why female gynecologists, on average, have fewer children than their male counterparts, and this difference is particularly high in upper hierarchical positions. Additionally, it is noteworthy that women in senior positions are more likely to be childless. These connections have also been described by Hancke et al. [14], who suggested that successful male physicians are often supported by a partner who either does not work or works part-time, whereas successful women in senior positions typically share their lives with equally successful partners [24].
In the FARBEN cohort, women were more likely to hold a doctorate but were less inclined to pursue a habilitation (highest university degree in German-speaking countries). This observation aligns with data from Häussler et al. [25], which found that young female residents are more frequently doctoral graduates than their male counterparts, yet they publish significantly less, even though publication rates at higher levels (such as department heads) were similar. Further study is needed to determine whether improving work-life balance or offering targeted support, such as mentoring programs, could increase women’s interest in pursuing higher academic degrees.
Regarding preferred working time models, only 12.5% of respondents favored full-time positions. It is important to note that the actual hours spent at work often exceed the typical full-time weekly hours due to on-call duties during nights, weekends, and holidays. Although 87.5% of respondents preferred part-time work, only 36.8% actually had part-time employment. This discrepancy was particularly evident among residents, with only 12.5% preferring full-time positions, yet 63.0% working full-time. This context should include a discussion of the differences in full-time employment regulations across the individual DACH countries (Germany, Austria and Switzerland), as well as the varying legal provisions regarding parental leave and maternity protection (see [Table 4]).
To address these circumstances and ensure that the field remains attractive for both upcoming and young physicians in the long term, it is essential to promote solutions such as expanding childcare facilities with flexible hours and adequate capacity, as well as offering more flexible working hours. This will provide all physicians, regardless of their life situation, with the best possible opportunities for career development in alignment with their personal preferences. Although expanding childcare capacity was already emphasized in 2012 by the DGGG e. V. Commission on Family and Career [14], participant preferences have not changed, and the demand for flexible childcare options remains as high as it was twelve years ago. While our survey did not assess the need for and availability of care for school-aged children, adequate capacity for homework assistance and holiday care is also essential to balance both career and family responsibilities effectively. In line with our results, a recent survey of medical students in Germany identified both work-life balance and working hours as significant factors influencing their choice of future specialty [26].
With the anticipated increase in part-time workers, it is also important to discuss the expansion of medical school placements, as more personnel will be needed to adequately cover the workload at medical facilities. In this context, another critical issue is the high cost of medical education, which the German Federal Ministry of Education and Research currently estimates to be around € 200000 per person [27]. Although costs per student remain unchanged, more students will be required to account for part-time work or longer professional interruptions. Delegating certain tasks to non-medical personnel, such as documentation assistants, ward secretaries, or physician assistants, could be another solution. This relatively new profession in Germany is already well established in the United States [28] [29] [30].
Amid current and future challenges, maintaining the highest level of patient care is essential. Appropriate measures and the establishment of new concepts should always align with patient-centered interests while weighing potential advantages and disadvantages. In this context, it should be noted that patients generally desire continuous care, such as during a hospital stay or illness. Meeting this need is already complicated by the participation of the medical team in on-call duties, which results in absences, and poses a particular challenge in the case of part-time employment.
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Strengths and Limitations
The proportion of women among the respondents was significantly higher than that of men (90.8% vs 8.6%). This could possibly be attributed to the fact that the proportion of women in specialist medical training for gynecology is much higher, and particularly young female doctors tend to engage with topics such as the compatibility of career and family, as well as working time models. Additionally, the young forums of the respective participating national countries (Germany, Austria and Switzerland) represent all doctors in training and thus have a high visibility in relation to this professional group. This is also reflected in the age structure of the participants (83.6% were between 18–40 years old). While 12.3% of the respondents were senior physicians with personnel responsibility, the results must be critically discussed in terms of possible implications and structural adjustments to particularly consider the opinions of senior and, especially, chief physicians. Furthermore, only a small percentage of gynecologists working in outpatient practices participated in the survey (5.8%), which may be related to the recruitment process of this survey, as it was promoted primarily through social media and clinical training sessions, which are mainly targeted at younger colleagues. The opinions of self-employed gynecologists on this consensus-based questionnaire are of great importance, as these doctors have consciously chosen not to pursue a hospital career. However, conclusions about this professional group are limited due to the small number of participants in this subgroup.
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Conclusions
This trinational survey systematically collected and analyzed preferences on topics such as working time models and career goals for the first time. To the best of our knowledge, surveys with larger sample size (n = 1364) have not been conducted. The results indicate a need for more medical personnel in order to accommodate the expected rise in family leave and part-time models among physicians in the future. It remains unclear whether the high preference for a reduction in working hours can be attributed to the increasing bureaucratic workload and the many additional hours spent on standby duty. The survey clearly highlights the need for expanding and improving childcare services to ease the professional burden on parents. It should also be emphasized that patient interests remain a top priority, and any potential structural changes should always take these interests into account.
Due to the high percentage of women in the field of gynecology and obstetrics, some developments are becoming evident earlier than in other disciplines. Engaging in open discourse around these developments and viewing them as opportunities can help address future challenges in the job market successfully. This approach could enhance colleague satisfaction, promote equality and individuality, and ultimately improve patient care while ensuring long-term sustainability.
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Contribution to the Manuscript and Online Survey
The entire boards of the DGGG e. V., OEGGG, and SGGG made an extraordinary contribution to the success of the study and manuscript through discussions, substantive input, and diverse support.
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Details of Ethics Approval
The manuscript was submitted to the Ethics Committee of the University of Luebeck and was evaluated favourably. Date of approval 20.09.2023. Reference number 2023–644.
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Supplementary Material
Appendix: Questionnaire, including all questions directed to participants from all nations.
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Contributorsʼ Statement
NT, NA, PF, AK, CB, RK, NK, SS, BS, BT, AR, MBP contributed to planning the survey and study conception. Material preparation, data collection and analysis were performed by NT, NA, MBP, BS, BT, TE, MM. The first draft of the manuscript was written by NT, NA, PF, AK, CB, RK, BT, ER, TE, MBP and all authors (including NK, MG, NT, EB) commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Conflict of Interest
The authors declare that they have no conflict of interest.
Acknowledgement
The results of the FARBEN survey were presented for the first time at the DGGG Congress on October 17, 2024, in Berlin during the session titled: “Medical Training in Gynecology and Obstetrics in European Countries”.
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- 27 Bundesministerium für Bildung und Forschung. Kosten des Medizinstudiums für den Staat. 2024 Accessed November 19, 2024 at: https://fragdenstaat.de/anfrage/kosten-des-medizinstudiums-fuer-den-staat/%23nachricht-861053
- 28 Gerst T. Arztentlastung: Der Assistent soll’s richten. Dtsch Arztebl Ausg A 2015; 112: A608
- 29 Korzilius H, Osterloh F. Nichtärztliche Gesundheitsberufe: Ärzte sollen entlastet werden. Dtsch Arztebl Ausg A 2017; 114: A1302-1304
- 30 Hu X, Coplan B, Barnes H. et al. Physicians working with physician assistants and nurse practitioners: perceived effects on clinical practice. Health Aff Sch 2024; 2: qxae070
Correspondence
Publication History
Received: 19 November 2024
Accepted after revision: 27 December 2024
Article published online:
11 February 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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